Lori Gold 12/31/2018MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk
Tel: (305) 673-741 1, Fax: (305) 673-7254
Email CityClerk@miamibeach.gov
December 16, 2016
Ms. Lori Gold
3 Island Ave. PH H
Miami Beach, Florida 33139
SUBJECT: Personnel Board
Dear Ms. Lori Gold:
Congratulations! You have been reappointed by the City Commission to the above referenced board or
committee, fora term ending: 12/31/2018.
If you are unable to accept this appointment or have any questions, please call the Office of the City Clerk
at 305.673.7411.
Please read the enclosed materials carefully. Congratulations and good luck.
Respectf
Rafael Granado
City Clerk
cc: Saul Frances, Parking Director
, City Liaison
ATTACHMENTS:
Letter of Appointment
Oath
City Code/Ordinance section applicable to agency, board or committee
City Code Section 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
Ordinance No. 2006-3543 - Amendment to City Code Section 2-22
Miami -Dade County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance
City Wide Permit Application - (Parking Department Form)
Booklet - Guide to the Sunshine Amendment and Code of Ethics for Public Officers and Employees
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
OFFICE OF THE CITY CLERK, Rafael Granado, City Clerk
Tel: (305) 673-7411, Fax: (305) 673-7254
Email CityClerk@miamibeach.gov
TO: Ms. Lori Gold
RE: Personnel Board
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United
States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a member of the
above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a
term ending: 12/31/2018.
I have been issued a copy of section 2-11.1 of the Miami -Dade County Code (Conflict of Interest and
Code of Ethics Ordinance), as well as Florida Commission on Ethics Guide to the Sunshine Amendment
and Code of Ethics for Public Officers and understand that as a member of a City of Miami Beach Board
and/or Committee, I must comply with the financial disclosure* requirements of Miami -Dade County or the
State of Florida (depending on the board or committee on which I serve) on July 1st, following the closing
of the calendar year on which I have served.
Sworn to and subscribed before me this off, day of f AN, 201,x`.1
v
Ramon Quezada
Deputy Clerk
*Please visit the City of Miami Beach website at www.miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
MIAMIDADE
COUNTY
SOURCE OF INCOME STATEMENT
Section 2-11.1(i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending
2016
Last Name First Name
Go /d Lor,.
Middle Name/Initial
Mailing Address — Street Number Street Name, or P.O. Box
1 a AN -Q..)
h — I—E
City, tate, Zip
f7 ,g7i-S9
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the following page and check here. 0
Filing as an Employee (check one)
Filing as a Board Member (check one)
County
El/Municipal: IN \ l J(Y\ l
(Municipality)
Board where serving
'--P-42),..tc5-ii)--' \
Alternate address (if home address is exempt)
Work telephone
C 75(0. 3q0 '71"( V((
Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.❑
Name of Source of Income
Address
County Public Health Trust ii1 Municipal:
(Municipality)
Department
Position or Title
Employee ID Number
Work address
Work telephone
Employment began on/ended on
Filing as a Board Member (check one)
County
El/Municipal: IN \ l J(Y\ l
(Municipality)
Board where serving
'--P-42),..tc5-ii)--' \
Alternate address (if home address is exempt)
Work telephone
C 75(0. 3q0 '71"( V((
Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, check here.❑
Name of Source of Income
Address
Description of the Principal Business Activity
L }V\ \i Q *;rv,\\,5
S' -\'Oc_CS
t,(-exmm-e,N--)\-
Si-- o F- &-1/4-
�c2c.._ ;Q Q -
hereby swear (or affirm) that the information above is a true and correct statement.
Sig 1 're o erson Disclosing
7/(
Da a signed
RECEIVED BY ELECTIONS DEPARTMENT:
❑ Hardcopy
❑ Electronic Copy
OFFICE USE ONLY Accepted: Y / N Deficiency:
138 SP -14 COE 2016
Processed Date/Initials:
Scanned Date/Initials:
AW\ 1 B LAC H
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www.miamibeachfl.gov
CITY CLERK'S OFFICE CityClerk@miamibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for BoardlCommittee Members for failure to comply with Miami -
Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2)
Board Member's Name: /6) t
CA)P
I understand that no later than July 1, of each year all members of Boards and Committees of the City of
Miami Beach, including those of a purely advisory nature, are required to comply with Miami -Dade County
Financial Disclosure Requirements. This means that the members of City Advisory Boards, whose sole or
primary responsibility is to recommend legislation or give advice to the City Commission, must file, even
though they may have been recently appointed.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year.
1. A "Source of Income Statement"
2. A "Statement of Financial interests (Form 1)"
3. A Copy of your latest Federal Income Tax Return
Failure to file one of these forms, pursuant to the Miami -Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
natur
Updated: Monday, April 20, 2015
Page 4 of 4
F:\CLER\BALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06022014.docx
v//7
Date
/\AIAM BEACH
Name:
DIVERSITY STATISTICS REPORTING
Lori G0{.
Board / Committee: NI' 50 " g 1
Appointment Date:
Pursuant to City of Miami Beach Ordinance 2009-3632, the City is required to annually
prepare and present a report to the City Commission identifying the City's diversity
statistics. This form allows board and committee applicants and members to voluntarily
self -identify their race, ethnicity, disabled status and gender.
Please check the appropriate box for each category:
Gender: Male Female L
P/
Race/Ethnic Categories
What is your race?
[1.) --,,,, African-American/Black
'C;aucasian/White
Asian or Pacific Islander
Native-American/American Indian
ED Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latino/a? Mark the "No" box if not
Spanish, Hispanic, Latino/a.
No
Yes
Do you consider yourself Physically Disabled?
C:\Users\CENTFraN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\NP4J9CNX\6C minority
information form 05-20-13 FINAL.doc
Updated: Monday, January 26, 2015
MIAMI BEACH
BOARD AND COMMITTEE APPLICATION FORM
Last Name
Go IA
First Name
LCD le- 1
Middle Initial
6
Home Address
e H
Home Telephone Work Telephone
Business Name
City State Zip Code
7F(0' 3 7 k7y`' Lfloy t'cAoici aoLcov
Cellular Telephone Email addr ss
Occupation
Business Address
Professional License (describe):
City
State
Expires:
Please attach a copy of currently effective professional license.
Zip Code
Pursuant to City Code section 2-22(4)a & b: Members of agencies, boards and committees shall be affiliated with the
City. This requirement shall be fulfilled in the following ways: a. An individual shall have been a resident of the City for
a minimum of six months; or b. An individual shall demonstrate ownership/interest for a minimum of six months in a
business established in the City for a minimum of six months.
• Resident of Miami Beach for a minimum of six (6) months: Yes [Ior No
• Demonstrates ownership/interest in a business in Miami Beach for a minimum of six months: Yes ❑ or No
• Are you a registered voter in Miami Beach: Yes aor No
• I am now a resident of: North Beach South Beach La Middle Beach
• I am applying for an appointment because I have special abilities, knoy�v edge and experience. Please list below:
rrVA rick P. 6'v) e n � Ci \J e,AC-vl vY\C' X\+ a.O f' -f C r a-C�'t' I c e e'? -F 1 a U)
J
• Are you presently a registered lobbyist with the City of Miami Beach? Yes or No
Please list your preferences in order of ranking [1] first choice [2] second choice, and [3] third choice. Please note that
only three (3) choices will be observed by the Office of the City Clerk.
0 Affordable Housing Advisory Committee
-rt
0 Health Advisory Committeeo0
❑Parks and Recreation F itities Board
VA in Public Places Committee 3
0 Health Facilities Authority Boardrsonnel
Board
0 Audit Committee
0 Hispanic Affairs Committee
0 Planning Board**
0 Board of Adjustment**
0 Historic Preservation Board{
0 Police Citizens Relations Committee
0 Budget Advisory Committee
0 Housing Authority
0 Production Industry Council
r,�Committee on the Homeless
0 Human Rights Committee
0 Sister Cities Program
,2
0 Committee for Quality Education in MB
0 LGBT Advisory Committee
0 Marine & Waterfront Protection Authority
0 Sustainability Committee
0 Transportation, Parking, & Bicycle -Pedestrian
Facilities Committee
0 Convention Center Advisory Board
0 Cultural Arts Council
0 Miami Beach Commission for Women
0 Visitor and Convention Authority
0 Design Review Board*
0 Normandy Shores Local Government
Neighborhood Improvement
0 Youth Commission
0 Disability Access Committee
* Board members are required to file Form 1 - "Statement of Financial Interest" with the State.
*If you seek appointment to a professional seat (e.g., lawyer, architect, etc.) on the Board of Adjustment, Design Review
Board, Historic Preservation Board or Planning Board, attach a copy of your currently -effectively license, and furnish the
following information:
Type of Professional License License Number
License Issuance Date License Expiration Date
Page 1 of 4
F \CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
°° Note: If applying for the Youth Center positions of the Parks and Recreations Facilities Board, please indicate your affiliation with
the Scott Rakow Youth Center and/or the North Shore Parks Youth Center:
• Please describe your past service with the City's Youth Centers (include dates of service):
• Present participation in Youth Center activities by your children: Yes [II No
If yes, please list below the names of your children, their ages and the programs in which they participate:
Child's name: Age: Program:
Child's name: Age: Program:
• Have you ever been convicted of a felony? Yes Li or No Ll If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach Code? Yes or NoZ If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money? Yes or No Lel If yes, explain in detail:
i
• Are you currently serving on any City Board or Committee? Yes or No If yes, which board/committee? r..„ e 1
• In wh?t organization(s) in the City ofMiamiBeach do you currently hold membership?
b,/NG 2 Li G' ctt � � 7 O la 4/Ll4?'imA
Position
Na jd C! !r (&_.t.JY O(
i
Name Position ,
• List all properties owned or irk which you have an interest within the City of Miami Beach:
4-4141 ii
r I Other — Print Race:
Do you consider yourself to be Spanish, Hispanic or Latinola? Mark the "No" box if not Spanish, Hispanic, Latino/a.
Z No
Yes
Do you consider yourself Physically Disabled?
LD Yes
NOTE: IF APPOINTED, YOU WILL BE REQUIRED TO FOLLOW CERTAIN LAWS THAT APPLY TO CITY BOARD/COMMITTEE
MEMBERS. THESE LAWS INCLUDE, BUT ARE NOT LIMITED TO:
o Prohibition from directly or indirectly lobbying City personnel (Miami Beach City Code section 2-459).
o Prohibition from contracting with the City (Miami -Dade County Code section 2-11.1).
o Prohibition from lobbying before the board/committee you have served on for period of one year after leaving office (Miami Beach
City Code section 2-26).
o Requirement to disclose certain financial interests and gifts (Miami -Dade County Code section 2-11.1).
o CMB Community Development Advisory Committee: prohibition, during tenure and for one year after leaving office, from having
any interest in or receiving any benefit from Community Development Block Grant funds for either yourself, or those with whom
you have business or immediate family ties (CFR 570.611).
o Sunshine Law - Florida's Government -in -the -Sunshine Law was enacted in 1967. Today, the Sunshine Law regarding open
government can be found in Chapter 286 of the Florida Statutes. These statutes establish a basic right of access to most
meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities.
o Voting conflict — Form 8B is for use by any person serving at the county, city or other local level of government on an appointed or
elected board, council, commission, authority or committee. It applies equally to members of advisory and non -advisory bodies
who are presented with a voting conflict of interest under Section 112.3143, Florida Statutes.
Upon request, copies of these laws may be obtained from the City Clerk.
I HEREBY ATTEST TO THE ACCURACY AND TRUTHFULNESS OF THE APPLICATION; AND I HAVE RECEIVED, READ AND
DARDS OF CONDUCT FOR
WILL ABOFFICERS,EMPLOYEES ANDAG NICYOF MEMB RS AND ALL OTHER APPLICABLE COUNTYTHE MIAMI BEACH CITY CODE, ENTITLED AND/OR CITY AND/OR STA E LAWS AND
STATUTES ,ACCORDI NG LYf"
Applia2n
Received in the Office of the City Clerk by:
D to
L0R( GoL_c
Name of Applicant (PLEASE PRINT)
L
Name of Deputy Clerk
ilir/6
Control No.
///f/4
Date
ATTACH A CURRENT RESUME, PHOTOGRAPH AND A COPY OF ANY
APPLICABLE PROFESSIONAL LICENSE.
ATTACH ADDITIONAL SHEETS, IF NECESSARY, TO PROVIDE REQUIRED
INFORMATION.
Page 3 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
MAM BEACH
City of Miami Beach
1700 Convention Center Drive,
Miami Beach, Florida 33139,
www. m i a m i bea chfl . gov
OFFICE OF THE CITY CLERK
CityClerk@miamibeachfl.gov
Telephone: 305.673.7411 Fax: 305.673.7254
Acknowledgement of fines/suspension for Board/Committee Members for failure to comply with Miami -
Dade County Financial Disclosure Code Provision Code Section 2-11.1(1) (2)
Board Member's Name:
c `tel C))d
I understand that no later than July 1, of each year all members of Boards and Committees of the City of
Miami Beach, including those of a purely advisory nature, are required to comply with Miami -Dade County
Financial Disclosure Requirements. This means that the members of City Advisory Boards, whose sole or
primary responsibility is to recommend legislation or give advice to the City Commission, must file, even
though they may have been recently appointed.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year.
1. A "Source of Income Statement"
2. A "Statement of Financial Interests (Form 1)"
3. A Copy of your latest Federal Income Tax Return
Failure to file one of these forms, pursuant to the Miami -Dade County Code, may subject the person to a fine
of no more than $500, 60 days in jail or both.
Si
Updated: Tuesday, October 04, 2016
Page 4 of 4
F:\CLER\$ALL\aFORMS\BOARD AND COMMITTEES\BC APPLICATION REVISED 06142016.docx
i///o/l
Date
LORI GOLD, J.D., M.S.
3 ISLAND AVENUE, PH -H
MIAMI BEACH, FL 33139
Mobile: (786) 390-7444
ttlorigold@aol.com
EDUCATION:
B.A., 1963, QUEENS COLLEGE, UNIV. OF CITY OF N.Y.
M.S. IN EDUCATION, 1965, CITY COLLEGE, UNIV. OF CITY OF N.Y.
J.D., 1983, EMORY UNIVERSITY, ATLANTA, GA.
PROFESSIONAL WORK EXPERIENCE
SCHOOL PSYCHOMETRIST, DIRECTOR OF ELEMENTARY SCHOOL
GUIDANCE PROGRAM, TEACHER
ATTORNEY, RETIRED MEMBER OF THE GEORGIA BAR
EXECUTIVE DIRECTOR GEORGIA PROFESSIONAL LICENSING BOARDS
DIVORCE MEDIATOR & TRAINER OF MEDIATORS
RECOGNITION & HONORS
2006 MIAMI BEACH KIWANIAN OF THE YEAR
1981 WHO'S WHO IN AMERICAN WOMEN
1980 LEADERSHIP ATLANTA
COMMUNITY LEADERSHIP ACTIVITIES (FLORIDA 1996 -PRESENT)
2006-2016 EESAC COMMITTEE, TREASURE ISLAND ELEMENTARY SCHOOL
2006-2016 PRESIDENT, BOARD MEMBER, FAMILY COUNSELING
SERVICES OF GREATER MIAMI & THE JOURNEY INSTITUTE &
SWITCHBOARD MIAMI
2016 FUNDING ARTS NETWORK
2012-2013 MIAMI BEACH CITIZENS POLICE ACADEMY
2007-2008 COMMITTEE FOR QUALITY EDUCATION IN MIAMI BEACH
2005-2006 MIAMI BEACH NEIGHBORHOOD LEADERSHIP ACADEMY ,
SECRETARY OF ALUMNI ASSOCIATION
2000-2007 KIWANIS CLUB OF MIAMI BEACH
1999-2004 TERRACE TOWERS CO-OP BOARD MEMBER; VICE PRESIDENT;
CHAIR OF BYLAWS REVISION AND LEGAL MATTERS COMMITTEES
COMMUNITY LEADERSHIP ACTIVITIES (GEORGIA 1969-1996)
PUBLIC ACCESS TELEVISION, PRESIDENT
55 PHARR ROAD CONDOMINIUM ASSOCIATION, PRESIDENT (6 YEARS)
AND MEMBER OF THAT BOARD FOR 8 YEARS
BRANDEIS WOMENS COMMITTEE, CHAIR OF COMMITTEES
ARTS FESTIVAL OF ATLANTA, CHAIR OF COMMITTEES
NATIONAL COUNCIL OF JEWISH WOMEN, CHAIR OF COMMITTEES